JPH0623055A - Catheter apparatus and treatment method using catheter - Google Patents

Abstract

PURPOSE: To make a catheter, such as an expansible catheter for medical treatment which is to be inserted into a patient's body, or its guide wire exchangeable during the treatment. CONSTITUTION: This catheter has a lumen 14 over the length of the catheter for receiving a guide wire 27. A first guide wire port 15 to be attached to the catheter main body 11 is formed at the tail end of the catheter, and a second guide wire port 17 is formed at a prescribed distance from the first guide wire port in the axial direction, and a third guide wire port 18 is formed at the top of the catheter. All these guide wire ports are inserted into the lumen 14 for receiving the guide wire 27.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a catheter device, and more particularly to a catheter device suitable for intravascular medical treatment such as (PTCA) and capable of exchanging a guide wire and a catheter during treatment.

[0002]

2. Description of the Related Art In conventional (PTCA) therapy, a guide catheter having a predetermined shaped tip is inserted into the patient's cardiovascular system, and the tip of the catheter reaches the vicinity of the entrance of the coronary artery. The guide catheter is designed to be twisted at its distal end, and with some torque applied, to rotate its distal end so that the distal end of the catheter is guided to the inlet. The balloon portion at the tip, and the tip of the inflatable catheter having a guide wire that is slid into the lumen of the catheter body is inserted while being guided through the guide wire.
The tip of the guide wire that is advanced to the target site is usually manually formed, for example, by bending, by a surgeon or his assistant, and then the guide wire is inserted into the inflatable catheter together with the guide catheter. First, the guide wire projects from the tip of the guide catheter and reaches the patient's coronary artery. Torque is applied to the distal end of a guidewire that extends outside the patient's body to guide the tip of a curved or otherwise shaped guidewire to its desired location within the coronary artery. Advancement of the guidewire within the target coronary artery is continued until the guidewire tip reaches the lesion. The advancement of the inflatable catheter continues further beyond the tip of the guide catheter until the balloon at the tip has reached the proper position beyond the lesion. Thus, once in position, the flexible but non-contractile balloon will have a relatively high pressure (eg, 4-12).
It is inflated by a radiopaque fluid (atmospheric pressure) to a preset size to inflate the affected part of the artery. The balloon withdraws the inflatable catheter and deflates when blood circulation begins.

For further details of procedures using such guide catheters, inflatable catheters and guide wires, see US Pat. No. 4,323,071 (Simpson, Robert), US Pat. No. 4,439, 185
(Lundquist), US Pat. No. 4,468,
224 (Enzman et al.), U.S. Pat. No. 4,
516,972 (Samsang), US Pat. No. 4,
438,622 (Samsung et al.), U.S. Pat. No. 4,554,929 (Samsung et al.), U.S. Pat. No. 4,582,185 (Samson), U.S. Pat. No. 4,616,652. Specification (Simpson),
U.S. Pat. No. 4,638,805 (Powell),
Described in US Pat. No. 4,748,986 (Morison et al.), US Pat. No. 4,898,577 (Bajar et al.), US Pat. No. 4,748,982 (Holzewski et al.). ing.

Recently, the applicant of the present invention has put on the market an improved inflatable catheter. This inflatable catheter is described in US patent application Ser. No. 07 / 550,801 (Yock) dated Jul. 9, 1990 and US Pat.
748,982 (Holzewski et al.). The inflatable catheter has a short guidewire receiving sleeve or inner lumen extending forward from the tip of the catheter. The sleeve extends at least 10 cm, and typically 25 cm from the distal guidewire port to another guidewire port. A slit is provided in the wall of the catheter body, the slit extending from the second guidewire port to near the proximal end of the inflation balloon.
This type of catheter design allows for rapid catheter replacement without the need to replace the wire or the need to attach an extension wire to the distal end of the guidewire.

The catheters improved by the inventions of Yok, Holzewski and others have been well received by medical personnel and have achieved commercial success in the market. However, it has been pointed out that the guide wire cannot be replaced when the catheter is used. For example, the shaped tip of the guidewire may deform during use, or the shape of its tip, the size of the guidewire, may be unsuitable for a particular procedure on a patient's artery. In such cases, the surgeon may wish to withdraw the guidewire to shape the tip or replace it with another guidewire of appropriate size, stiffness, and shape. However, in the above-described catheters improved by Jock, Holzewski and others, withdrawal of the guide wire loses the advantage of having the catheter tip reach the desired lumen of the artery through the guide wire into the lumen of the catheter. Will end up. And, unfortunately, it is not possible to diagnose whether the guidewire or catheter needs to be replaced during the procedure prior to inserting the guidewire into the patient.

[0006]

What is needed and unavailable at the present time is to allow the patient's intended lesion to be reached during treatment of the patient's arterial lesion, yet still quickly. A catheter device capable of exchanging a catheter or a guide wire. Therefore, it is an object of the present invention to solve the above-mentioned problems of the prior art and to provide a catheter device satisfying this object and other needs.

[0007]

SUMMARY OF THE INVENTION The present invention is a catheter body having an elongated inner catheter body having a distal end and a distal end for receiving a guide wire, the inner lumen extending from the distal end of the catheter body to the distal end. A first body for communicating with the inner lumen, which is provided at the distal end of the catheter body and which is formed at the distal end of the catheter body forming a part of the inner lumen for receiving a guide wire and the patient. A guidewire port and a catheter body forming a part of an inner lumen for receiving the guidewire, at a distance of at least 10 cm from the distal end of the catheter body in the vicinity of the treatment means and at a sufficient distance from the distal end of the catheter body. And a second guide wire port provided at a position where the guide tube communicates with the inner lumen and a distal end portion of the catheter body. It is third in communication with the inner lumen
It is characterized by comprising a guide wire port and a guide wire slidably inserted into the inner lumen.

The present invention is directed to a catheter device for use with a wire guide type wherein either the guide wire or the catheter through the guide wire can be replaced during a medical procedure such as the PCTA procedure. And a treatment method using such a catheter.

The present invention also provides that an elongated catheter body having a distal end and a distal end is formed with an inner lumen for receiving a guide wire, the inner lumen extending from the distal end to the distal end of the catheter body and for inflation. A catheter body whose lumen extends through the catheter body to the tip, an inflatable balloon portion in communication with the inflation lumen at the tip of the catheter body, and a portion of the inner lumen for receiving a guidewire. Is formed at the distal end of the catheter body forming
A first guidewire port in communication with the inner lumen and a catheter body forming a part of the inner lumen for receiving the guidewire, at a position at least 10 cm away from the distal end of the catheter body in the vicinity of the treatment means And a second guide wire port provided at a position sufficiently away from the distal end of the catheter body and communicating with the inner lumen, and a third guide provided at the tip of the catheter body and communicating with the inner lumen. It is characterized by comprising a wire port and a means provided at the distal end of the catheter body for guiding the inflation liquid into the lumen.

In the embodiment, as the catheter,
A catheter suitable for performing a type of PTCA treatment in which the balloon is inflated is described. This catheter is
Two lumens of approximately equal length are formed inside the catheter body. Of these, one lumen is a lumen for receiving the guide wire, and the other lumen is provided for guiding the liquid into the inside of the inflation balloon provided at the tip of the catheter. One of the attractive features of such a catheter is that when the catheter is applied to a conventional wire-guided dilatation catheter, both the catheter and the guide wire can be replaced for PTCA treatment. It is also possible to apply to other types of catheters having a treatment means at the tip.

To facilitate separation of the guidewire and catheter for replacement, a slit is formed in the wall of the catheter body which forms part of the lumen for receiving the guidewire. The first slit extends axially from the first guidewire port to the second guidewire port. The second slit extends from the second guidewire port to near the treatment means.

In order to replace the catheter during the PTCA treatment, the guide wire is used as a guide, and the catheter reaching the affected area is pulled out from its distal end. If the guide wire extends from the second guide wire port, the catheter can be removed by splitting it at the slit.

If the guidewire exits the first guidewire port, the catheter is pulled from the first guidewire port to the second guidewire until it is withdrawn from the end of the adapter until the guidewire is at the second guidewire port. It is separated from the guide wire by tearing a slit that extends to the wire port. Subsequent detachment of the catheter from the guide wire is similar to that described above. The catheter is then withdrawn until the tip of the catheter is at the end of the guide catheter with the guidewire held in the fingers.

When the catheter is removed from the distal end of the guidewire that is still inserted into the body, the distal end of the guidewire is inserted into the third guidewire port at the tip of the catheter to be replaced, and the catheter is , Follow the guidewire and navigate the patient's artery. The distal end of the guide wire may be guided out of the catheter body, either through the second guide wire or the first guide wire, at the surgeon's discretion.

In the case of the catheter device according to the present invention, the guide wire can be exchanged while holding the catheter so as not to be dislocated from the treatment position of the cavity in the body even during the treatment of the lumen. When replacing the guidewire, it is possible to pull it out of the inner lumen of the catheter, holding the end of the guidewire out of the patient's body. After removing the guide wire from the catheter, this time, insert the replaced guide wire into the inner lumen of the catheter from the guide wire port, and pass it through the inner lumen.
It can be advanced through the third guidewire port at the tip of the catheter and advanced to the affected area of the desired patient lumen. If the end of the loaded guidewire exits the second guidewire port of the catheter, the replacement guidewire is inserted through the first guidewire port through the end of the inner lumen and then the guidewire. Can be extracted to prevent the catheter from shifting from the position of the affected area. When the exchanged guide wire is advanced through the catheter, for example, when the diseased part in the artery of the patient is accurately reached, the catheter is advanced as a guide to the exchanged guide wire as described above, The desired treatment can be taken.

The catheter according to the present invention also allows for the withdrawal and reinsertion of a replacement guidewire, for example, when the surgeon attempts to change the shape of the guidewire tip during the procedure. When performing such a procedure, the guide wire inserted into the body is basically withdrawn in the same manner as described above, and the guide wire with the shaped distal end is attached to the catheter inserted into the body. It is installed in the same manner as above.

As will be apparent from the detailed description given below, the catheter according to the present invention is applicable to various treatments. These advantages are described in detail below in conjunction with the accompanying drawings.

[0018]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the catheter device according to the present invention will be described below with reference to the accompanying drawings. 1 through 4 depict an inflatable catheter device 10 embodying features of the present invention. This catheter 10 allows the guide wire to be exchanged even while the catheter remains in the affected area of the patient, and even when the guide wire remains in the affected area, the catheter is exchanged to a predetermined arterial position. The catheter can be reached. Catheter 10 generally comprises an elongated catheter body 11, a lumen 12 for directing inflation fluid from the distal end of catheter body 11 to the interior of an inflatable balloon portion 13 at the tip, and lumen 1 thereof.
2 has an inner lumen 14 extending therein for passing a guide wire.

The wall of the catheter body 11 forms at least a portion of the inner lumen 14 for receiving the guidewire,
A first guidewire port 15 located at the distal end 16 of the catheter body, a second guidewire port 16 at least 10 cm away from the first guidewire port 15 at the distal end of the catheter body, It includes a third guidewire port 18 located at the tip. The second guide wire port 16 has a larger diameter than the first guide wire port 15 does.
It is provided at a position sufficiently close to 8.

The adapter 20 is mounted at the distal end of the catheter body position to facilitate the introduction of inflation fluid into the inflation lumen 12. The inflation lumen 12 is guided into the inflation balloon portion 13 through the port 22.

The first slit 23 is preferably formed in the wall of the catheter body. In this case, the wall of the catheter body forms an inner lumen 14 for receiving the guide wire and extends to the first guide wire port 15 and the second guide wire port 17. The second slit 24 is
It is formed in a portion of the wall portion of the catheter body 11 that extends from the second guide wire port 17 to near the proximal end portion 25 of the balloon portion 13.

The catheter body 11 is provided with an extension pipe 26 at its tip, and the extension pipe 26
Protrudes from the tip of the balloon portion 13 through the inside. The extension tube 26 is also configured to receive the guidewire 27 within the inner lumen 14 therein. The coil 2 is attached to the tip of the guide wire 27.
8 is formed and the catheter body 11 as shown
The guide wire extends from the third guidewire port 18 of the distal end portion 19 of the guide wire and passes through the inside of the catheter body 11 from the third guidewire port 18. In this case, the guide wire 27 is the inner lumen 1
4 is inserted through the second guide wire port 17 at the end of the catheter body. The elongated core member 29 is adapted to emerge from the distal end of the catheter body 11 through the first guidewire port 15.

The X-ray non-transmissive body 30 is provided inside the balloon portion 13 of the extension tube 26 so as to facilitate observation with a fluoroscope during the treatment of the arterial system. The other radiopaque bodies 31, 32, and 33 are also provided at the distal end of the catheter body 11 so that the surgeon can confirm the positions of the guide wire port 15 and the second guide wire port 17 by using a fluoroscope. You can do it.

The catheter device according to the present invention is inserted into a patient by a method of previously passing a guide wire through the inner lumen 14. The guidewire 27 may then exit the first guidewire port 15 or, alternatively, the distal end of the guidewire may be extended to the second guide, such as when using a catheter modified by Jock or Hauszewski. It can be inserted into the patient as it emerges from the wire port 17.

When it is desirable or necessary to replace either the catheter 10 or the guidewire 27 at any time during the procedure, the catheter 10 or the guidewire 27 is located inside the patient. Either the 10 or the guide wire 27 can be utilized to pull and replace the distal end of the patient, in which case the catheter can be brought to the desired arterial location.

That is, if the guidewire needs to be replaced, the catheter 10 is left in place while the guidewire 27 is withdrawn from the guide catheter by its distal end. Guide wire 27 from catheter 10
When the catheter is withdrawn, the guidewire to be replaced is replaced from the first guidewire port 15 outside the patient's body to the inner lumen 1
4. Insert the guide wire 27 until the distal end of the guide wire 27 jumps out from the third guide wire port 18 and enters the artery of the patient. Once the exchanged guidewire 27 is inserted into the patient's coronary artery, the catheter 10 is further inserted through the artery under the guidance of the guidewire 27 to a predetermined position, such as the dilatation or other procedure performed in this type of procedure. The action is taken.

When the catheter 10 having the distal end of the guide wire 27 extending from the first guide wire port 15 is pulled out, the guide wire and the catheter are separated by pulling the catheter while pulling the guide wire port wire through the slit 23. To separate. In this case, the guide wire is pulled until it comes out of the second guide wire port 17. Further, the guide wire is pulled through the slit 24 to the guide wire port 24 and pulled out from the catheter. In this way, the guide wire is grasped by fingers until the distal end of the catheter reaches the distal end of the guide wire, and the distal end of the guide wire is pulled out of the catheter 10. Even when the guide wire 27 has come out of the second guide wire port 17 from the beginning, the catheter 10 is removed by the same procedure except that the catheter 10 does not need to be peeled off from the guide wire 27 by passing through the slit 23. You can take it out. Catheter 1
When 0 is extracted, a new catheter to be replaced is attached to the distal end portion 19 by inserting a guide wire. The catheter is guided by the guide wire passing through the lumen 14 and is advanced until the guide wire reaches the second guide wire port 17. And this exchanged catheter is
It is inserted into the patient as described above.

As another method, the exchanged catheter is attached to the guide wire 27 in the same manner as described above, and the catheter is advanced by using the guide wire as a guide until the distal end comes out from the first guide wire port 15 of the catheter. In this way, the entire exchanged catheter can be inserted into the patient's artery.

Another embodiment of the present invention is shown in FIGS. In this embodiment, the guide wire 27 is inserted into the central arm of the two arm adapters 35 attached to the distal end of the catheter body 11. The components corresponding to those of the embodiments of FIGS. 1 to 4 except this point are designated by the same reference numerals, and the description thereof will be omitted. In this embodiment, the first guide wire port 15 (not shown) is formed at the distal end of the catheter body 11 and opens into the adapter 35. The method of using the catheter of this embodiment is basically the same as that of the embodiment of FIGS. The adapter 35 has a slit 44 continuous with the slit 23 of the catheter body 11.

The catheter body 11 is made of polyethylene, vinyl chloride, polyester or the like, US Pat.
It is molded by conventional extrusion from a material suitable for arterial catheters as described in 1,478 (Eberd et al.). Other components are attached to the catheter, for example, by an adhesive sold under the trade name Loctite based on acrylonitrile. Heat shrinkage is employed where appropriate. Also, as described in U.S. Pat. No. 4,638,805 (Powell) and U.S. Pat. No. 4,821,722 (Samson et al.), The balloon is inserted before the catheter is inserted into the patient in advance. A spitting valve may be provided to discharge the air in the section.

The size of the catheter body 11 and the inner lumen 14 for receiving the guide wire is determined by the size of the guide wire 27 to be used, the artery into which the catheter is inserted, and the size of the body cavity. In general, the inner diameter of the lumen of the catheter is preferably such that the guide wire can be worn by sliding. The outer diameter of the guide wire used for the artery is 0.008 to 0.035i
nch (0.2 to 0.69 mm). The inner diameter of the lumen 14 for receiving the guide wire is about 0.001-0.0
It is 05 inches (0.025 to 0.127 mm), which is larger than the outer diameter of the guide wire 27. The catheter body 11 has a length (100 to 150 cm) that extends sufficiently long from the distal end of the guide catheter so that treatment can be performed inside the patient's body. Therefore, when inserting from the thigh, the catheter can be inserted by 10 cm.
The wall of the catheter has sufficient thickness and strength so that it does not interfere with pushing the catheter into the blood vessel of the patient. If necessary, at the distal end of the catheter,
A stiffening member may be attached to facilitate insertion of the catheter into the patient's body.

The present invention has been described above with reference to the embodiments relating to the inflatable catheter used for coronary arteries.
The present invention is not limited to this, and can be used, for example, as a catheter to be inserted into various body cavities. Therefore, it goes without saying that various design changes can be made within the scope of the present invention.

[Brief description of drawings]

FIG. 1 is a partial cross-sectional side view showing an embodiment of a catheter device of the present invention.

2 is a cross-sectional view taken along line 2-2 in FIG.

FIG. 3 is a cross-sectional view taken along the line 3-3 in FIG.

FIG. 4 is a cross-sectional view taken along the line 4-4 in FIG.

FIG. 5 is a partial cross-sectional side view of a catheter device of the type in which the guidewire exits the distal end adapter according to another embodiment.

6 is a cross-sectional view taken along line 6-6 in FIG.

7 is a cross-sectional view taken along the line 7-7 in FIG.

[Explanation of symbols]

 10 Catheter Device 11 Catheter Body 13 Balloon Part 14 Inner Lumen 15 First Guide Wire Port 17 Second Guide Wire Port 18 Third Guide Wire Port 20 Adapter 23 First Slit 24 Second Slit 27 Guide Wire

Claims (13)

[Claims] 1. A catheter for inserting into a cavity in a patient's body for diagnosis or treatment, wherein a guide wire or a catheter can be exchanged even when the catheter is in the patient's body. An inner lumen for receiving a guide wire is formed in an elongated catheter body having a distal end, the inner lumen extending from the distal end of the catheter body to the distal end, and the inner lumen is provided at the distal end of the catheter body for treatment inside the patient. A first guidewire port in communication with the inner lumen, the first guidewire port being formed at the distal end of the catheter body forming a portion of the inner lumen for receiving the guidewire; At least 10c from the distal end of the catheter body in the vicinity of the treatment means and formed in the catheter body forming a section A second guide wire port provided at a position m away from the distal end of the catheter body and communicating with the inner lumen, and a second guide wire port provided at the distal end of the catheter body and communicating with the inner lumen. And a guide wire slidably inserted into the inner lumen. 2. The treatment means is an inflatable therapeutic balloon portion, the inflation lumen extends from the distal end of the catheter body to the interior of the balloon portion, and the first guidewire port is at the distal end of the catheter body. The catheter device according to claim 1, wherein the catheter device is located. 3. The catheter device according to claim 1, wherein the position where the second guide wire port is formed is not separated from the distal end portion of the catheter body by 50 cm or more. 4. The first guidewire port according to claim 1, wherein the first guidewire port is formed at a position apart from the distal end portion of the catheter body by 0.5 cm to 30 cm. Catheter device. 5. A catheter device suitable for diagnostic procedures performed in a patient's artery, wherein an elongated catheter body having a distal end and a distal end defines an inner lumen for receiving a guidewire, the inner lumen of the catheter body being formed. A catheter body extending from the distal end to the tip and having an inflation lumen extending to the tip within the catheter body; and an inflatable balloon portion provided at the tip of the catheter body in communication with the inflation lumen. A first guidewire port formed at a distal end of the catheter body forming a portion of an inner lumen for receiving the guidewire and communicating with the inner lumen, and forming a portion of the inner lumen for receiving the guidewire The distal end of the catheter body is formed on the catheter body and is located at least 10 cm away from the distal end of the catheter body near the treatment means. A second guidewire port provided at a position sufficiently away from the inner lumen, a second guidewire port communicating with the inner lumen, a third guidewire port provided at a distal end portion of the catheter body and communicating with the inner lumen, and a catheter body A catheter device at the distal end of the catheter for directing inflation fluid into the lumen. 6. A slit is formed in at least a wall portion of a catheter body forming a guide wire receiving lumen, and the slit extends axially from the second guide wire port to a position near the treatment means or the balloon portion. The catheter device according to any one of claims 1 to 5, wherein the catheter device is formed so that the guide wire and the catheter body can be separated. 7. A slit in the wall of the catheter body forming at least a lumen for receiving a guide wire is formed between the first guide wire port and the second guide wire port. The catheter device according to claim 5. 8. A method of treatment with a catheter in a patient's artery, wherein an elongated inner catheter body having a distal end and a distal end defines an inner lumen for receiving a guidewire, the inner lumen being the distal end of the catheter body. A catheter body extending from the tip to the tip, a means for performing a procedure within the patient's body at the tip of the catheter body, and a distal portion of the catheter body forming part of an inner lumen for receiving a guide wire, A first guidewire port communicating with the inner lumen and a catheter body forming part of the inner lumen for receiving the guidewire, at a position at least 10 cm away from the distal end of the catheter body in the vicinity of the treatment means. A second guide wire provided at a position sufficiently away from the distal end of the catheter body and communicating with the inner lumen. And a third guidewire port provided at the distal end of the catheter body and communicating with the inner lumen. A catheter device comprising: a third guidewire port; The distal end of the guide wire that is ejected from the guide wire port and is ejected from the third guide wire port is inserted so as to reach the arterial system, the catheter is advanced into the coronary artery through the guide wire, and a diagnosis is performed using a treatment means. Treating and maintaining the position of the catheter accessible to the patient's coronary artery, pull the guidewire distally to withdraw the guidewire from the patient's arterial system and advance the replaced guidewire through the inner lumen of the catheter, Insert the catheter into the coronary artery of the patient and advance the catheter over the replaced guide wire. , Methods of treatment using a catheter, characterized in that to reach a desired position within a patient's coronary artery. 9. The treatment means is an inflatable therapeutic balloon portion, and the catheter has an inner cavity for guiding an inflation liquid from the distal end portion of the catheter body to the inside of the balloon portion. A treatment method using the catheter according to claim 8. 10. A method of catheter-based treatment performed in a patient's artery, wherein an elongated inner catheter body having a distal end and a distal end defines an inner lumen for receiving a guidewire, the inner lumen being the distal end of the catheter body. A catheter body extending from the tip to the tip, a means for treating a patient provided at the tip of the catheter body, and a distal portion of the catheter body that forms part of an inner lumen for receiving a guide wire, A first guidewire port communicating with the lumen and a catheter body forming a portion of an inner lumen for receiving the guidewire, at a location at least 10 cm away from the distal end of the catheter body near the treatment means. A second guidewire port that is provided at a sufficient distance from the distal end of the body and communicates with the inner lumen. And a third guidewire port provided at the distal end of the catheter body and communicating with the inner lumen, using a catheter device comprising: Insert the tip of the guide wire that has come out from the 1 guide wire port and jumped out from the 3 rd guide wire port so as to reach the arterial system, and while holding the position of the guide wire that can reach the patient's circular artery, A treatment method using a catheter, which comprises pulling the catheter out of a patient's arterial system, advancing the catheter through the guide wire and advancing the catheter to reach a target position in the coronary artery of the patient. 11. A catheter to be exchanged, wherein an elongated catheter body having a distal end portion and a distal end portion is formed with an inner lumen for receiving a guide wire, the inner lumen extending from the distal end to the distal end of the catheter body, and the catheter. A first guidewire port provided at the distal end of the body and formed at the distal end of the catheter body forming a portion of an inner lumen for receiving a guidewire and for communicating with the inner lumen. And formed in the catheter body forming a part of the inner lumen for receiving the guide wire, and having a sufficient distance from the distal end portion of the catheter body at a position at least 10 cm away from the distal end portion of the catheter body in the vicinity of the treatment means. A second guide wire port provided at a position and communicating with the inner lumen, and a distal end of the catheter body. Vignetting, methods of treatment using the catheter according to claim 10, wherein the third guidewire port to the communication with the inner lumen, in that it consists of. 12. The guide wire distal end is inserted into the third guide wire port of the exchanged catheter distal end,
12. The catheter of claim 11, wherein the replaced catheter is advanced until the end of the guidewire is at the position of the second guidewire port before the replaced catheter enters the coronary artery of the patient. The treatment method used. 13. The guide wire distal end is inserted into the third guide wire port of the exchanged catheter distal end,
12. The catheter of claim 11, wherein the replaced catheter is advanced until the distal end of the guidewire is at the first guidewire port before the replaced catheter enters the coronary artery of the patient. The treatment method used.